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51075.5 (4) i a sJ c No. Street Lot No. o — a APP,LIC'A�IONT4 RvPLWMISIN RMIT U ) CCFY:OF-CUP R-YIN OCT 18 1968 S t!�j No �F. Date 196 6;7 Permit No�yy 7S',S 3 CITY Or CUPERTINO Fee Ste_ Application is hereby made to the City of Cupertino for a permit to install plumbing pipes and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures `o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other 'c laws applicable thereto. A Use of Premises r.J /lOC�4...--.•�/ /`l�_� o v Owner f'�(7 x/ �C 7- 0107 Address c BY dyGL f-/X-- 4- Address GJ�y�70'�tti/efr.�:�2✓ 3 Contractor,Agent Phone 2G VLZ SCS m3 SGL ( State License 7- 14 Approv / �h umbmg lnspector r/ FIXTURES NUMBER MAIN DRAIN Units Fees Units Fees Water Heater Size Water Closet Material Bath Tub To Curb Shower To Prop. Line Lavatorics To Existing Kitchen Dish Washer Waste Disposal Wash Tray STORM DRAINAGE Washing Machine Size Water Softener Material Bar Sink To Main Drain Comb.Sink&Tray To Curb Dental Unit Drinking Fountain Floor Drain WATER SYSTEM Hopper UMatena Restaurant Sink Relief Valve I Ga�s Fee Sand TrapEES Urinal ,d 0 Area Drain e Wa L eSprinkler System Vac Breaker Skimmer .Filter Permit Fee -2 , 00 Total Total Fee D D